Saturday, June 25, 2016

Emotional Intelligence

Chapter Seven
Emotional Intelligence
                        Having established a framework for family therapy and done some initial assessment, it is time to introduce, model, and practice a language of feelings to talk about these issues.  It is, after all, the emotional content that distinguishes function from dysfunction, that drives thought and behavior, and that disconnects or connects people in relationship.  Here I recall the psycho-education material from the second session, often replaying my training presentation for the child or adolescent to illustrate my point.  Then, using Daniel Siegel’s hand/brain demonstration (2003, p. 173) I ask parents and children to hold up a hand as I describe the parts of the brain and their roles in physiological functioning, storing pre-conscious emotional memories, and decision making.  My hand up flat, pointing to the wrist I start.
“The wrist represents the brainstem, the earliest, oldest part of the brain, responsible for involuntary functions like respiration and temperature, the part that sends our hearts racing and our skin sweating when we are excited or scared.  Now fold over your thumb like this.  The thumb represents the emotional brain, the limbic brain, also primitive in development, active before birth, and responsible for storing memories of early experiences before our conscious awareness.  This is the part that remembers the first time we sat on our bottoms or how it felt to be held and fed, or how it felt when Mom was stressed out about being pregnant, or how it felt to be left alone and hungry.  Next, fold your fingers over your thumb.  This represents the thinking brain, the cortex, neo-cortex, and pre-frontal lobes that start forming in utero but are not finished until about 25 years old.  This is the part of the brain that remembers experiences with words and stories, that learns math and science, that makes decisions about what to do or not to do, most active after the age of four.  Now these three parts are connected and communicate with each other, except when they don’t, for example when we are excited or scared.  That’s when we sometimes ‘lose our minds’ and go into what’s called fight/flight/freeze mode, when we need to fight back from attack, or run away, or stay still because we are in danger or think we might be.  This is a good thing.  For example, if you are driving down the highway and somebody almost hits your car, your brain tells you there’s a threat to your life and your body needs to defend itself.  The eyes widen to look around, the arms and legs get tense to drive the car, and the heart and lungs start pumping blood and oxygen to make everything work faster and stronger.  You do not stop to think, ‘That guy probably just had a bad day,’ no that part of your brain is not on, you need to save your life.  So, you hit the gas, or you hit the brake, or you stay right where you are.  Then, when the danger is over you begin to think about what to do, whether you are hurt, whether the car is damaged, whether to call the insurance company or the police.  Your thinking brain comes back on.  The hard part is that for some people who have experienced scary things, even things they can’t remember, their brain disconnects and they go into fight/flight/freeze when they are excited or scared even when they are not in any real danger, but think they are.  It can happen often all day long like when a car cuts us off in traffic, or a teacher raises her voice, or when Dad tells us to turn off the X-Box.  Then, when someone talks to us we can’t hear them because that part of our brain is not on, and it sounds like Charlie Brown’s teacher, ‘Wah, wah, wah, wah, wah.’  That’s what the teacher means when he says, “Put your thinking caps on.” That’s why it’s important for us to know and parents to know when it happens so we can help get our brains back on.  It’s also important to know that sometimes we overreact because our baby brain remembers when we were alone or hungry and as if we’re going to die.  Because, babies can die when they are alone or hungry.  It takes our thinking brain to tell us we’re going to be OK.  But first the thinking brain has to be on.  And, that’s what we’re going to work on, getting back to calm, so the parts of our brain can work together.”

This silent visual then becomes a signal or sign language for when a child or parent
feels regulated and calm or dysregulated and upset.  Time and time again throughout the process I will ask or the child will volunteer how they are feeling using the hand gesture, sometimes with closed hand indicating they are ready to delve deeper into distressing material, or slightly open hand indicating they need to be nurtured and soothed and it is time to breathe and play.  Similarly, I put my closed hands together to represent the left and right parts of the brain, how the left brain is responsible for logical thought and the right brain is responsible for emotional experiences, and how we are going to help the two sides of the brain work together.
            The next activity is about developing an emotional vocabulary.  I like to start by having parents read their child a book like Today I Feel Silly and Other Moods That Make My Day by the actress Jamie Lee Curtis (1998).  I specifically ask the question, “Is it OK to be angry?”  The reason is that some parents and people send children and other adults the message, directly or indirectly, that anger is an inappropriate or unacceptable emotion.  Nothing could be less helpful.  The message of this children’s book and all other clinical work, reinforced by therapeutic language and activities, is that all emotions are valid.  Identifying, expressing, and managing specific and multiple emotions are essential to healing.  And, hearing and validating feelings are essential skills to strengthening relationships including the parent-child relationship.  Active or reflective listening does not come automatically or naturally to some, especially those who have never been on the receiving end.  A game like Candyland can be a simple start.  I call it “Feelings Candyland” and ask parents and children to play together and sometimes I join in to normalize feelings and normalize the expression of emotions so that as we move through difficult experiences we can focus on emotional content.  For Feelings Candyland I use the gingerbread men pieces, a die, but no colored cards.  I ask the child to give a feeling word to each color on the board from red to green to yellow to purple.  I may offer suggestions to make sure we cover the big ones; happy, sad, angry, scared.  Often adults are stuck with a limited vocabulary for emotions.  A side benefit, although not the most important one, is that I can determine whether the child can count and knows colors in addition to feelings.  Then, each participant tosses the die, moves that many spaces, and describes a time when they have that feeling or what makes them have that feeling based on the assigned colors.  We play for a few minutes.  I sometimes suggest it for family activities.  Children often ask to return to the game sometimes with creative sophisticated emotional language.
            Another fun theraplay game is Feelings Tic Tac Toe.  The grid on plain paper has nine emojis each representing an emotion.  The child is encouraged to place an M&M or fish cracker, or if you want to be healthy a carrot coin, on each face and tell when they have that feeling or what makes them have that feeling.  The rules are, if they fill up the card, they get to eat the “game pieces” but they may not feed themselves.  I take a beat here to wait for the child, and parent, to figure out how this can happen.  Often traumatized children feel the need to take control of everything because they do not trust adults to do so, and parents consider that an older child should feed themselves and that feeding an older child seems like coddling them.  However, just like the couple at a wedding who feed each other cake, the parent feeding the child is not just an important symbol of their nurturing role but a chance to recreate an early developmental experience.  I encourage parents to do it often with food and bottles, baby bottles, juice boxes, or sports drinks, even for much older children, and to make it loving and playful.  The same goes for other parent-child activities like reading books, lap rocking, backrubs, combing hair, hide and seek, and wrapping in blankets, as long as it does not trigger the child.
            Aristotle provided a good definition of emotional intelligence, “to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way.”  It is difficult for adults let alone children.  Scaling emotions is a start.  I start by laying out colored paper each with numbers one through five.  Using angry and happy as an example, I act out examples from the child’s life that would rate anger at level 1, like not getting ice cream for dessert, to moderate anger, 3, like a friend saying something mean, to the highest level 5, a family member getting hurt on purpose.  I start quiet with a disappointed facial expression and no body movement, move up to words, “I’m upset” with clenched fists, up to a full loud jumping tantrum, “That’s not right!”  Parents and children may acknowledge that the child’s emotional scale has a default setting of five.  Then I ask the child to demonstrate using the emotion happy.  Children usually need some guidance from parents to rate the amount of emotion to match the event.  Sometimes parents are not comfortable with the extreme levels of emotion children may feel or express in relation to rather serious trauma events like being starved or sexually abused.  Often the level of emotion children display over rather mundane issues is really about the traumatic events.  Sometimes parents are not comfortable with any but the most urbane expression of emotion.  Culture plays a role here, too, what is acceptable in different families. This can keep parents disconnected from their children because they are not able or willing to attune to the child’s emotions, many times because they have difficulty acknowledging the depth of the child’s trauma.  Certainly, parents may display extreme emotion when a child is misbehaving.  It takes some coaching to help a parent display extreme emotion over events that seem past for the parent but are very present for the child.  This is what I attempt to model.
            This activity can be used in two other ways.  Having identified several typical life events and acted out the associated feelings, we then talk about the various places in which emotions happen.  Then, using the 1-5 scale we talk about in which places different emotional expressions would be acceptable and safe.  For example, “it’s probably pretty important to stay on a 1 at a restaurant or church, but where would it be OK to go all the way up to a 5?”  The child or parent may say, “Nowhere.”  Most often I suggest a tall mountain, the beach, or the backyard where others are not around.  Parents will often suggest the child’s room.  The point is there must be a safe place, both emotionally and physically, for a child to express extreme emotions, and most beneficially with their parents.  Next, I ask the child to stand on the number and color that represents the level of emotion their parents expect most of the time, particularly at home.  With back turned toward parents the child will often stand on 1.  I send a signal to parents to move the child to 2 or 3 demonstrating that the parent does not expect the child to be perfect and will accept high levels of emotion.  The child is often surprised.  Then, I ask the child to stand on the 5, and with some cheering from me and parents to really get loud.  This is the exact opposite of what parents usually do in trying to shut down an exuberant display.  Sometimes predicting a tantrum can take the steam right out of it.  In this case, I ask the child to “scale it down” as they continue with an emotion but with reduced energy.  It demonstrates that with their brain fully engaged, which is usually not the case during tantrums, and the support and understanding of their parents, a child may have the capacity at least to regulate themselves.  Parents are often surprised that a fun and exciting experience can lead to a complete “meltdown” because the child cannot self-regulate. This is an activity I either reference or return to throughout the therapeutic process.
           Because emotional intelligence entails more than verbal expression I often use a collection of small percussion instruments from session to session.  I demonstrate how each instrument is played then allow family member to experiment with several.  In several different formats, I lead with an instrument playing a specific rhythm and then ask each person in the circle to match the rhythm.  Each person takes a turn leading.  Then I ask parents and children to play the major emotions; happy, sad, angry, scared.  No talking is necessary, the emotion is communicated with rhythm, timing, and volume and heard and matched by the others which is the very definition of attunement.  We attune and empathize through the use of non-verbal signals more than with language.  To help parents and children communicate with each other without the intrusion of language, I ask them to “speak” to one another using the instruments alone.  What results is a back and forth “conversation” the theme of which is usually pretty easy to follow.  Then the pair explains what they were “saying” to each other, and more often than not their words match their communicated intentions. 
Another important emotion that is difficult for children and adults but which is at the core of attachment trauma, especially adoption, is sadness.  We must develop an understanding and skills around grief and loss.  For this I turn to children’s books; Horace (Keller, 1991), Rosie’s Family (Rosove, 2001), or other similar stories to open a conversation about sadness.  Then I bring out the puppets to tell sad stories.  Using puppets takes the focus away from the person and makes expressing sadness safer.  Each person in the family chooses a puppet, we go around and introduce them by made-up names, and I start with my puppet telling a simple sad story about a classmate breaking my favorite pencil.  By turn, each person uses their puppet to tell a sad story.  Almost inevitably, the stories become sadder and sadder and much more real.  If not, I go to my “born in a litter, raised on a farm, sold to the city, living with strangers” farm animal story that highlights the themes of separation from parents, siblings, and place of birth.  As parents and therapists, we are “loss managers”, we have to have a comfort level around grief and loss as if we are “running the funeral home” and know how to guide children through the process, specifically by highlighting events and creating rituals that mark deaths and other transitions.  Rituals that include letters to loved ones, poems, songs, pictures, candles, life books, flowers, food, and other memorializing means are excellent in-session activities and homework for families.  Throughout therapy we must be alert to sadness and not dismiss or overlook it.  For example, a teenager whose biological mother would not apologize for abandoning her fell silent.  We could have moved on to school, sports, or other subjects.  But noticing the moment and waiting in silence allowed for 45 minutes of comfort and connection between child and parent with cathartic tears releasing years of sadness that had come out in every other way than healing. It was a scene right out of the excellent movie Inside Out (Disney Pixar, 2015) which illustrates the essential role of sadness and all emotion in giving color and context to life.  Without sadness we could not gauge happiness.  Without emotion life would be rather grey and boring.  It is the rainbow of emotion, both heat and light, that makes us human.  Emotions are individual and never wrong.  Parents and partners can agree with the feelings and not with the facts of a specific situation.

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